U.S. will maintain metrics on the NATO use of the system, which will allow regular reports to NATO on such items as

Data usage on a monthly basis

Number type of medical specialties consulted

Response time for each consult

Audit reports

Individual case use analysis

20U.S. Army Responsibilities

Permit access to the Teleconsultation System by NATO and PFP medical personnel deployed in Afghanistan

Maintain a consultation management system which ensures that all teleconsultations are routed to an appropriate consultant, that a response is given in a timely manner (lt 8 hours) , and maintain appropriate metrics to document usage, successes, and problems

Provide system description, instructions, and guidance on use of the system to NATO Medical Advisor, suitable for distribution to deployed NATO and PfP medical personnel

21NATO Responsibilities

NATO Medical Advisor will

Insure use of this system is incorporated into Operational Orders

Publish and distribute the instructions and guidance provided by the U.S. Army to all deployed clinical providers in Afghanistan

Insure that providers are trained in the use of the system

22U.S. Army MEDCOM/NATO MOU Status

NATO approved in June 2007 the U.S. Army teleconsultation offer for NATO use in Afghanistan.

US Army approval expected in September 2007

NATO staffing to begin after US Army signature completed

Deploy TMED system in FY08, Q2 to Afghanistan (tentative)

Australia military in Afghanistan also interested in using the U.S. Army system

23Topics

U. S. Army Tele-Consultation System for Deployed Forces

USA/NATO TMED MOU in Afghanistan

USA/Kosovo collaborations

Conclusions

24U. S. Army Telemedicine Support to KosovoKosovo Telemedicine Center in PristinaCamp Bondsteel, U.S. Army 25Kosova Telemedicine Center (KTC)

Inaugurated - December 2002 as an integral part of the University Clinical Center of Kosova (UCCK)

Funded by the European Agency for Reconstruction - 1.5 million grant - Phase 1

U.S. Department of State (Bureau of Educational and Cultural Affairs) provided (Oct. 2006) an 850,000 grant to the Kosovo Foundation for Medical Development to further develop these programs (KTC as the major project partner) Phase 2

KTC regularly provides on-line and VTC-based educational programs not only in Kosova, but throughout the Balkans, with recent effors in Albania and Macedonia

KTC has an ongoing effort to further develop this capability throughout Kosovo involving development of 7 regional TMED centers - Phase 3

A large percentage of the NATO Alliance nations have considered that telemedicine is now a vital part of the medical armamentarium, and have either fielded or are planning to field telemedicine capabilities to support their deployed troops

A significant increase in fielded telemedicine systems demonstrated over the past several years.

5 nations felt that their national TMED capabilities could potentially be made available for NATO operations

2 nations reported negatively

9 did not feel able to comment on behalf of their nations

33NATO Telemedicine CapabilitiesFindings - 2

Communications at role 1 are highly prevalent, with both voice and internet access being available in the majority of national systems. This would imply that telemedicine systems which are web-based can have a significant future impact and availability, even down to Role 1 levels.

Analysis shows a significant penetration, current and planned, of teleradiology, particularly at roles 2 and above.

Most nations relying on Store and Forward technologies, rather than VTC for patient care.

34NATO Telemedicine CapabilitiesFindings - 3

Most nations do not have any formal structure for their teleconsultation systems, nor any brokered or centralized TMED consult system in place (relying primarily on personal relationships with consultants in the home country to guide teleconsultation)

Specialized Telemedicine (e.g. telepsychiatry, telemicrobiology, tele-medical maintenance, teledentistry, etc.) are still used only in a minority of reporting nations, but the technology to extend their use is now available if it is felt to fill a care gap

Electronic health records (EHR) are now in use or planned in a minority of nations, and in a still-smaller group are such records interoperable with that nations civilian EHR

35NATO Telemedicine CapabilitiesRecommendations

NATO COMEDS should recommend to the nations that Telemedicine capabilities be positively considered as a medical force extender and a positive asset to the quality of patient care, while assisting in reducing the size of the medical deployed footprint

Planning for the use of Telemedicine capabilities needs to be included in all doctrinal medical planning documents

Nations to be encouraged to ensure that their developmental and fielded telemedicine systems are in compliance with the interoperability requirements of STANAG 2517

Availability of deployable telemedicine capabilities be included in future versions of the Defense Planning Questionnaire (DPQ) and incorporated into the Force Goals/Force Planning Process.

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